Thursday, March 17, 2011

As a layperson I found Gaslighting... by Theo L. Dorpat a true gift. Through it I learned that the psychoanalytic process could be a useful and trustworthy tool in the treatment of mental illness. Before I read Gaslighting..., I harbored a great distrust for psychoanalysis and psychotherapy in general. Gaslighting... taught me it is not these great institutions that matter, but the individual persons who populate them and their kindness*.

It is hard to get across the impact this book has had without quoting it extensively, which I shall do. It has a very high signal-to-noise ratio. By that I mean it is jam packed with facts and truths, and I would recommend it for that alone.

Gaslighting... is a book about "covert methods of interpersonal control" both inside and outside of the therapeutic framework. It's not just about covert abuse in psychoanalysis but the role of covert abuse in the genesis of mental illness. This dual framework is what makes the book so amazing. Hopefully the first three sentences will peak the readers interest:

It has been said that fish don't know they swim in water until they are out of the water. Similarly, most people do not know about the subtle and covert types of interpersonal control, domination, and abuse they are exposed to all of their lives in their families, at their schools, or in their workplace. Not until they have experienced relationships that are more caring, respectful, and nonmanipulative are they able to recognize how much they have been covertly manipulated, controlled, and abused by others. (1)

Aptly covered is the concept of "projective identification", Dorpat's definition:

In projective identification, the subject first unconsciously projects unwanted aspects of themselves onto another person and pressures the object to contain, as it were, the subject's disavowed affects and contents. (6)

This is a primary form of gaslighting, which I assert, is unfortunately used quite commonly on children unwittingly by their parents becoming the source of many, in Dorpat's words, "pathogenic beliefs" often seen by clinicians.

Dorpat covers many covert methods of interpersonal control in the therapeutic situation including the aforementioned projective identification, a form of gaslighting which "...is an attempt to impair or destroy an individual's confidence in his or her psychic abilities". (7) Also covered are questioning, "defense interpretation", confrontations, interrupting or overlapping communication, and abrupt change of topic all which can lead to a "fragmenting [of] the patient's experience" (11).

I want to emphasize that although this book emphasizes the therapeutic framework, it also recognizes the covert methods that are endemic in society.

Dorpat wastes no time with a brief, simple but scathing critique of behavioral therapy and it's use of rewards and punishment, noting that "Humans have used rewards and punishment as effective means of training and attaining social control over others... for millions of years" (22), concluding that behavioral therapy is merely a means of getting patients to "act normal"(23). [In the interest of revealing my own bias, I would add that CBT is even more insidious with the "C" merely a proxy for brainwashing.]

Dorpat includes numerous, rich case studies to explore the dynamics of psychoanalysis. By studying where psychoanalysis goes wrong he manages to show its immense worth by saving the baby from the bathwater. He discusses a patient's reaction to attacks on the patient's judgements and perceptions noting the patient's "self-esteem fell as his confidence in his reality-testing and mental functions was markedly lowered." (36)

Dorpat skillfully portrays the use of questioning (quite simply, asking questions) as a method of control. In a vignette he reaches a beautiful conclusion of what a patient tries to communicate about the author's use of questioning: "Don't worry about not immediately knowing something about me. Your questions are pushing me away!" (54) Dorpat takes a very hard line on questioning, stating that it is only useful "in situations where the therapist is uncertain about the meaning of something said by the patient...". (71)

Gaslighting... shows some ways psychoanalysis can be counter-productive and the meat of this book illustrates in great detail, through vignettes, the disastrous results of covert interpersonal control in therapy. I fast-forward to the beautiful conclusions of this book. Extensively paraphrasing Wiess et al. (1986) Dorpat agrees:

Psychopathology stems from unconscious pathogenic beliefs of dangers if the patient were to pursue certain important goals. Unconscious pathogenic beliefs are irrational and they involve feelings of guilt, shame and anxiety. These are mainly formed in childhood out of traumatic relationships with parents and others... Patients are powerfully motivated to disconfirm these beliefs because they are maladaptive and grim, and they produce much mental pain. (238)

This is pure gold. Other conclusions are: to avoid the use of stereotyped psychoanalytic approaches (226); to recognize the importance of the nature of the analyst's interaction with the patient (231); and the importance of evaluating patient's responses to interventions by the analyst (247).

Much of my admiration for this book is due to the fact that it is very extensively sourced (a quality with which it shares in common the Pulitzer Prize winning "Denial of Death", Becker (1972)), drawing on works from A-Z including Hienz Kohut, Robert Langs, Joe Weiss, DW Winnicott, Eric Fromm, Bob Stolorow, and more than 100 others.

Gaslighting... is a great starting point for anyone interested in covert abuse, mental illness, psychoanalysis, and how power is unconsciously communicated in American society. I'll end with the books cogent epigraph:

For those who stubbornly seek freedom, there can be no more urgent task than to come to understand the mechanisms and practices of indoctrination. These are easy to perceive in the totalitarian ocieties, much less so in the system of "brainwashing under freedom" to which we are subjected and which we all too often serve as willing or unwitting instruments. Noam Chomsky, 1987

* Dorpat's kindness and caring is unconsciously woven though every page of the book.

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In 2005 a group of psychoanalysts & psychoanalytic psychotherapists convened to explore possibilities for meeting the educational needs of clinical professionals in the Tampa Bay area. Out of those discussions evolved a new institute, the Tampa Bay Institute for Psychoanalytic Studies. Consistent with the spirit of collegiality, openness, and diversity that inspired its development, the new Institute is non-authoritarian and democratic. Training programs utilize progressive and classical concepts which have been endorsed by contemporary critiques of psychoanalytic education. Believing that the capacity to think psychoanalytically best develops in an atmosphere of inquiry, open dialogue, and active participation the founding members sought to integrate these values into the structure of the new Institute and into the process of training. A precedent of collaboration and mutual respect for the contributions of all faculty and candidates was established enabling our mission to gain immediate representation in our actions.